Report on Medicare Compliance

  1. Physician Practice Settles FCA Case on Incident-To Billing, Adopts Compliance Procedures

    Report on Medicare Compliance Volume 31, Number 28. August 08, 2022  | Author: Nina Youngstrom  | August 08, 2022 

    In a false claims settlement over billing for incident-to services, North Country Neurology P.C., a physician-owned practice in Watertown, New York, has agreed to pay $850,000 about 16 years after it self-disclosed and returned a Medicare overpayment for similar conduct, the U.S. Attorney’s Office for the Northern District of New York said Aug. 2.[1] The new settlement focuses on the lack of direct physician supervision and includes improper billing for Botox injections...

  2. House Extends Telehealth Coverage, Senate Expected to Follow; There May Be Snags With MPFS

    Report on Medicare Compliance Volume 31, Number 28. August 08, 2022  | Author: Nina Youngstrom  | August 08, 2022 

    There’s a good chance Medicare coverage of telehealth services, including audio-only telehealth services, will continue through Dec. 31, 2024, a hard-and-fast date independent of whether HHS continues to extend the COVID-19 public health emergency (PHE), experts say...

  3. In Case of Lovebirds, Court Raises Bar for Kickback-FCA Connection

    Report on Medicare Compliance Volume 31, Number 28. August 08, 2022  | Author: Nina Youngstrom  | August 08, 2022 

    Romance and the Anti-Kickback Statute (AKS) don’t typically go together, but that was the backdrop of an appeals court decision that may make it harder for the Department of Justice (DOJ) to tie a kickback to a False Claims Act (FCA) violation, an attorney said.[1]...

  4. Due Diligence Checklist for Physician Practice Acquisitions

    Report on Medicare Compliance Volume 31, Number 28. August 08, 2022  | Author: Nina Youngstrom  | August 08, 2022 

    Here are some key considerations when conducting due diligence in acquisitions. The checklist was developed by PYA. View the checklist at https://bit.ly/3PaIGVO...

  5. CMS Transmittals and Federal Register Regulations, July 29-Aug. 4

    Report on Medicare Compliance Volume 31, Number 28. August 08, 2022  | August 08, 2022 

  6. News Briefs: Aug. 8, 2022

    Report on Medicare Compliance Volume 31, Number 28. August 08, 2022  | Author: Nina Youngstrom  | August 08, 2022 

    ◆ HHS on July 25 finalized its repeal of rules on Good Guidance Practices (GGP) and fairness in enforcement.[1] In a nutshell, the GGP and enforcement regulations, which were published in the waning days of the Trump administration, required HHS to put “significant” guidance through notice and comment rulemaking and limited the use of subregulatory guidance in administrative enforcement actions.[2]  ...

  7. HHS Revises Sec. 1557 Rule; Expands Definition of Sex, Adds 'Notice of Availability'

    Report on Medicare Compliance Volume 31, Number 27. August 01, 2022  | Author: Nina Youngstrom  | August 01, 2022 

    In a proposed rule again revising Sec. 1557 of the Affordable Care Act, the Biden administration would protect gender identity, sexual orientation and pregnancy from sex discrimination and bring back notice and other requirements that were dropped from the Trump administration’s version of the rule.[1] The proposed rule, announced by HHS July 25, is more in keeping with the Obama administration’s 2016 vision, with its notice of nondiscrimination and Sec. 1557 compliance officer, but it also introduced a “notice of availability” about language assistance and auxiliary aids. And as the latest incarnation makes clear, nondiscrimination requirements apply to telehealth services...

  8. After Disclosing a Reportable Event Under its CIA, Hospital Settles CMP Case With OIG

    Report on Medicare Compliance Volume 31, Number 27. August 01, 2022  | Author: Nina Youngstrom  | August 01, 2022 

    William Beaumont Hospital in Michigan has agreed to pay $1.732 million in a settlement with the HHS Office of Inspector General (OIG) that had a connection to its corporate integrity agreement (CIA). The allegations centered on the hospital’s physician compensation and leases under certain circumstances...

  9. Vein Ablation Denials Show Importance of Pre-Procedure Progress Notes

    Report on Medicare Compliance Volume 31, Number 27. August 01, 2022  | Author: Nina Youngstrom  | August 01, 2022 

    A hospital’s recent reversal of claim denials of varicose vein ablation is an object lesson in the importance of including pre-procedure progress notes and other essential documentation when responding to an auditor’s documentation request, a compliance officer said...

  10. In 'Dual Audit,' Lab Is Audited by Both I-MEDIC and MA Plan's SIU

    Report on Medicare Compliance Volume 31, Number 27. August 01, 2022  | Author: Nina Youngstrom  | August 01, 2022 

    A CMS program integrity contractor that focuses on Medicare Part C and D claims and a Medicare Advantage (MA) plan’s special investigative unit (SIU) are simultaneously auditing the same lab, a double whammy that took its attorney by surprise because of the volume of documentation requested both on the claims and on background information of the lab, including enrollment and certifications. He’s worried more provider audits may be in the works for claims submitted to MA plans by the program integrity contractor that had previously investigated only Part D fraud, waste and abuse, the attorney said...

  11. Tip Sheet to Help Prevent Inappropriate Orders of Pain Management, DME

    Report on Medicare Compliance Volume 31, Number 27. August 01, 2022  | Author: Nina Youngstrom  | August 01, 2022 

    Stormont Vail Health in Topeka, Kansas, distributes this tip sheet to physician offices to help patients avoid getting caught up in scams and potentially authorize pharmacies or durable medical equipment (DME) suppliers to ask their physicians to order prescriptions or supplies. The tip sheet gets at some of the same kinds of issues raised in the HHS Office of Inspector General’s July 20 special fraud alert that urges physicians and nonphysician practices to tread carefully “and use heightened scrutiny” when entering into arrangements with telemedicine companies, although the tip sheet wasn’t designed specifically for telemedicine.[1] Contact Barbara Duncan, HIPAA privacy...

  12. CMS Transmittals and Federal Register Regulations, July 22-28

    Report on Medicare Compliance Volume 31, Number 27. August 01, 2022  | August 01, 2022 

  13. News Briefs: August 1, 2022

    Report on Medicare Compliance Volume 31, Number 27. August 01, 2022  | Author: Nina Youngstrom  | August 01, 2022 

    ◆ CMS didn’t collect $416 million of the overpayments identified by the HHS Office of Inspector General (OIG) during the 27-month period from Oct. 1, 2014, through Dec. 31, 2016, according to an OIG report posted July 28.[1] There wasn’t documentation to support that CMS collected another $152 million in overpayments flagged by OIG, bringing the total to 55% in unconnected overpayments. According to the report, CMS had various reasons for not collecting overpayments, including provider appeals and redeterminations of overpayment amounts by CMS and Medicare administrative contractors (MACs). To improve overpayment recoupment, OIG made nine recommendations, such as establishing...

  14. DOJ Certification Raises CCO 'Risk Profile'; Consider 'Your Own Due Diligence Checklist'

    Report on Medicare Compliance Volume 31, Number 26. July 25, 2022  | Author: Nina Youngstrom  | July 25, 2022 

    A compliance officer’s certification that her organization was compliant with applicable laws and regulations as part of its false claims settlement with the Department of Justice (DOJ) has come back to bite her. The organization is considering a self-disclosure that implicates the certification, a cautionary tale for other compliance officers now that DOJ is expected to require chief compliance officers to sign certifications that their organization’s compliance program is “reasonably designed and implemented to detect and prevent violations of the law” and functioning effectively in the resolution of corporate criminal cases. That language has already made an appearance in Glencore...

  15. DOJ Alleges Fresenius Clinics Did Unnecessary Procedures; Compliance Raised Concerns

    Report on Medicare Compliance Volume 31, Number 26. July 25, 2022  | Author: Nina Youngstrom  | July 25, 2022 

    The Department of Justice (DOJ) said July 13 it has intervened in a whistleblower complaint against Fresenius Vascular Care Inc. (FVC) alleging medically unnecessary procedures were performed on patients with end-stage renal disease (ESRD) at nine of its clinics in New York.[1] With or without referrals from nephrologists and dialysis clinics, the Fresenius vascular access centers (VACs) allegedly did fistulagrams and angioplasties and held contests with prizes for new patient referrals, according to the False Claims Act (FCA) complaint in intervention.[2] Although the compliance department warned against the allegedly medically unnecessary procedures, DOJ said they continued...

  16. In Fraud Alert, OIG Cites 'Suspect' Telehealth Characteristics

    Report on Medicare Compliance Volume 31, Number 26. July 25, 2022  | Author: Nina Youngstrom  | July 25, 2022 

    In a special fraud alert posted July 20, the HHS Office of Inspector General (OIG) warns physicians and nonphysician practitioners (NPPs) to tread carefully “and use heightened scrutiny” when entering into arrangements with telemedicine companies.[1] Practitioners could run afoul of the Anti-Kickback Statute (AKS) and other federal laws if they accept fees for ordering medically unnecessary services, for example, that are reimbursed by federal health care programs. The alert, which is based on several years of enforcement in the telemedicine space, describes “suspect characteristics” that should help practitioners identify questionable arrangements...

  17. OIG Audit of Critical Care Finds High Error Rate; No Extrapolation

    Report on Medicare Compliance Volume 31, Number 26. July 25, 2022  | Author: Nina Youngstrom  | July 25, 2022 

    In a Medicare compliance audit of critical care services provided by Lahey Clinic in Burlington, Massachusetts, the HHS Office of Inspector General (OIG) found a high error rate.[1] But the overpayment amount was small and OIG didn’t extrapolate it...

  18. Sample Compliance Committee Charter

    Report on Medicare Compliance Volume 31, Number 26. July 25, 2022  | Author: Nina Youngstrom  | July 25, 2022 

    Here’s an example of a charter for a governance, compliance and ethics committee. It appears in the Health Care Compliance Association’s Healthcare Compliance Forms and Tools and was developed by Parkland Health and Hospital System.[1]...

  19. CMS Transmittals, July 15-21

    Report on Medicare Compliance Volume 31, Number 26. July 25, 2022  | July 25, 2022 

  20. News Briefs: July 25, 2022

    Report on Medicare Compliance Volume 31, Number 26. July 25, 2022  | Author: Nina Youngstrom  | July 25, 2022 

    ◆ Two Florida women, Analay Rico of Fort Lauderdale and Daylen Diaz of Miami, have pleaded guilty in connection with a conspiracy to falsify clinical trial data, the Department of Justice (DOJ) said July 20. They were study coordinators at the clinical research site Tellus Clinical Research. According to their plea agreements, they worked with others to defraud clients paying for clinical trial work on treatments for opioid dependency, irritable bowel syndrome and other conditions. “Among other things, Rico and Diaz admitted they falsified data to make it appear as though subjects were participating in the trials when, in truth,...

  21. Monitoring for Information Blocking Rule Improved Note Sharing; Button Is Confusing

    Report on Medicare Compliance Volume 31, Number 25. July 18, 2022  | Author: Nina Youngstrom  | July 18, 2022 

    Despite the plain meaning of the word, clicking the “share” button in EPIC will not result in the sharing of progress notes and other electronic health information (EHI) with patients, two compliance professionals said. EHI by default lands in the patient portal, and physicians and other clinicians don’t have to lift a finger to comply with a core requirement of the information blocking regulation.[1] In fact, pressing the share button will have the opposite effect...

  22. Tool to Monitor Note Sharing Under Information Blocking Rule/Tip Sheet

    Report on Medicare Compliance Volume 31, Number 25. July 18, 2022  | Author: Nina Youngstrom  | July 18, 2022 

    The University of Kansas Health System has developed a tool to monitor note sharing by providers as part of its compliance efforts under the information blocking rule, said Christine Hogan-Newgren, chief compliance and internal audit officer.[1] The screenshot shows some findings for one period of time. The numerator represents all the notes that were shared, and the denominator represents all the notes that should have been shared, with the tool therefore showing the percentage of total notes shared. Below it is a tip sheet developed by the compliance team at The University of Kansas Health System to help its providers,...

  23. MPFS Rule: Say Goodbye to Incident-To, Audio-Only Telehealth Services; CMS Adds Codes

    Report on Medicare Compliance Volume 31, Number 25. July 18, 2022  | Author: Nina Youngstrom  | July 18, 2022 

    Providers will say goodbye to the telehealth version of incident-to services at the end of the year if CMS finalizes a provision in the proposed 2023 Medicare Physician Fee Schedule (MPFS) rule announced July 7.[1] The same goes for audio-only telehealth services for the most part, although its kill date is different. They are two of the telehealth revisions in the proposed rule, which adds and shuffles codes around different Medicare coverage categories and incorporates the 2022 Consolidated Appropriations Act’s extension of Medicare telehealth coverage for 151 days past the end of the COVID-19 public health emergency (PHE). Although there...

  24. OIG: Hospice Provider Was Overpaid $140M; Lack of Policies Is Blamed

    Report on Medicare Compliance Volume 31, Number 25. July 18, 2022  | Author: Nina Youngstrom  | July 18, 2022 

    In possibly the largest overpayment finding ever in a Medicare provider compliance audit, the HHS Office of Inspector General (OIG) said Vitas Healthcare Corporation of Florida was overpaid $140 million.[1]...

  25. Meta Pixel Allegations Create HIPAA Risk for CEs, BAs, Experts Say

    Report on Medicare Compliance Volume 31, Number 25. July 18, 2022  | Author: Jane Anderson  | July 18, 2022 

    Facebook parent company Meta faces a class-action lawsuit following disclosure that a tracking tool installed on hospitals’ websites has been allegedly collecting patients’ protected health information (PHI)—including details about their medical conditions, prescriptions and doctor’s appointments—and sending it to Facebook...